2. Program Overview

The National Heart Institute (NHI) was established in 1948 through the National Heart Act with a mission to support research and training in the prevention, diagnosis, and treatment of cardiovascular diseases (CVD). Twenty-four years later?through section 413 of the National Heart, Blood Vessel, Lung, and Blood Act (P.L. 92-423)?Congress mandated the Institute to expand and coordinate its activities in an accelerated attack against heart, blood vessel, lung, and blood diseases. The renamed National Heart, Lung, and Blood Institute (NHLBI) expanded its scientific areas of interest and intensified its efforts related to research on diseases within its purview. Over the years, the Institute's areas of interest have grown to encompass genetic, genomic, proteomic, and metabolomic research; systems biology; sleep disorders; and the Women's Health Initiative (WHI).

The NHLBI provides global leadership for research, training, and education programs to promote the prevention and treatment of heart, lung, and blood diseases and enhance the health of all individuals so that they can live longer and more fulfilling lives.

The NHLBI stimulates basic discoveries about the causes of disease, enables the translation of basic discoveries into clinical practice, fosters training and mentoring of emerging scientists and physicians, and communicates research advances to the public. It creates and supports a robust, collaborative research infrastructure in partnership with private and public organizations, including academic institutions, industry, and other government agencies. The Institute collaborates with patients, families, health care professionals, scientists, professional societies, patient advocacy groups, community organizations, and the media to promote the application of research results and leverage resources to address the health needs of the public. The NHLBI also collaborates with international organizations to help reduce the burden of heart, lung, and blood diseases worldwide.

Each year, the NHLBI assesses progress in the scientific areas for which it is responsible and updates its goals and objectives. As new opportunities are identified, the Institute expands and revises its areas of interest. Throughout the process, the approach used by the Institute is an orderly sequence of research activities that includes:

Acquisition of knowledge

Evaluation of knowledge

Application of knowledge

Dissemination of knowledge

NHLBI Programs

The programs of the NHLBI, as shown in the following table, are implemented through five extramural units:

Division of Cardiovascular Sciences (DCVS)

Division of Lung Diseases (DLD)

Division of Blood Diseases and Resources (DBDR)

Division of Prevention and Population Sciences (DPPS)

Division for the Application of Research Discoveries (DARD)

and one intramural unit:

Division of Intramural Research (DIR)

The extramural divisions use a variety of funding mechanisms, such as individual research project grants, cooperative agreements, program project grants, Small Business Innovation Research (SBIR) grants, Small Business Technology Transfer (STTR) grants, Specialized Centers of Clinically Oriented Research (SCCOR) grants, comprehensive center grants, contracts, and research training and career development grants.

In fiscal year (FY) 2010, the DCVS was created by combining two previously existing divisions?the Division of Cardiovascular Diseases and the Division of Prevention and Population Sciences?so that the administrative structure would better match the dynamic interaction that exists among basic, clinical, and population sciences. Because the areas addressed by the two previous divisions are closely linked, the Institute believed that merging the two Divisions would stimulate the collaborative efforts that are needed to advance cardiovascular research.

Division of Cardiovascular Sciences

The DCVS supports basic, clinical, population, and health services research on the causes, prevention, and treatment of CVD and technology development for its diagnosis and treatment. The Division fosters research in atherothrombosis, coronary artery disease, myocardial infarction and ischemia, heart failure, arrhythmia, sudden cardiac death, adult and pediatric congenital heart disease, high blood pressure, stroke, cardiovascular complications of diabetes and obesity, and other cardiovascular disorders. A SCCOR supports clinical collaborative research in vascular injury, repair, and remodeling and a Centers Program supports cardiac translational research associated with preventing and treating heart failure and arrhythmias.

The Division's research portfolio includes a number of well-known epidemiological cohort studies that describe disease and risk factor patterns in populations; clinical trials of interventions to prevent disease and to reduce or eliminate risk factors; studies of the influence of genetic, behavioral, sociocultural, environmental, and health systems factors on disease risk and outcomes; and studies of the application of prevention and treatment strategies to determine how to improve clinical care and public health. The Division also supports research training and career development in these areas.

In addition to the Office of the Director, the Division is organized into three Programs, eight Branches, and three Offices, which are described below.

Basic and Early Translational Research Program

The Basic and Early Translational Research Program supports and provides leadership for basic, preclinical, and early translational studies on vascular biology and hypertension, cardiovascular surgery, and development of advanced technologies for diagnosis and treatment of CVD.

The Program is divided into the two branches described below.

Advanced Technologies and Surgery Branch

The Advanced Technologies and Surgery Branch supports integrated basic, translational, and clinical research to develop technologies for the diagnosis, prevention, and treatment of CVD. Research on diagnostics focuses on proteomic, genomic, and other biomarker technologies and on imaging modalities and agents. Therapeutics research focuses on tissue-, cell-, and gene-based therapies; regenerative and reparative medicine; image-guided therapies; and cardiac and circulatory support and repair devices. Research related to surgery addresses improved surgical and image-guided therapies and the translation of cardiovascular surgical advances into clinical practice. Enabling technologies research includes bioinformatics, computational and systems biology, bioengineering, nanotechnology, materials research, and personalized medicine.

Vascular Biology and Hypertension Branch

The Vascular Biology and Hypertension Branch supports integrated basic and clinical research on the etiology, pathogenesis, prevention, diagnosis, and treatment of hypertension and vascular diseases. Vascular biology focuses on the biology of the vascular wall and its role in hypertension and vascular diseases; the development of arteries, veins, lymphatics, and microcirculation; and angiogenesis. Vascular disease research focuses on cerebrovascular, renal, lymphatic, aneurismal, and peripheral vascular diseases. Hypertension research focuses on the study of blood pressure regulation?including central, renal, and vascular control?and cerebrovascular disease resulting from high blood pressure.

Adult and Pediatric Cardiac Research Program

The Adult and Pediatric Cardiac Research Program supports and provides leadership for basic, translational, and clinical research on development, maturation, and functioning of the heart throughout all stages of life. Areas of research include cardiac development and maturation, myocyte structure and function, myocardial energetics and metabolism, cardiac electrophysiology, coronary artery structure and function, the failing heart, valvular heart disease, exercise physiology, nutrition and the heart, congenital heart disease from birth through adulthood, the intrauterine environment and cardiovascular risk, cardiomyopathy, atherothrombosis, and coronary artery disease. A major function of the Program is to provide collaborative leadership for systematic oversight of clinical research across the Division, including clinical research information technology and standard but flexible operating procedures.

The Program is organized into the three branches described below.

Atherothrombosis and Coronary Artery Disease Branch

The Atherothrombosis and Coronary Artery Disease Branch supports integrated basic and clinical research on the etiology, pathogenesis, prevention, diagnosis, and treatment of coronary artery disease and atherothrombosis. Research on coronary artery disease focuses on acute and chronic coronary syndromes, including myocardial infarction; acute ischemia, angina, and silent ischemia; and percutaneous and surgical revascularization of stenotic and restenotic coronary lesions. Atherothrombosis research investigates atherosclerotic lesions in coronary arteries and other arterial beds; lipid fractions and interactions with the arterial wall; lesion instability, vulnerable plaques, and thrombosis; and biomarker and imaging diagnostics to quantify plaque and atherosclerosis progression. Atherothrombosis research also includes studies of diet, exercise, diabetes, obesity, and other metabolic conditions related to atherothrombosis.

Heart Development and Structural Diseases Branch

The Heart Development and Structural Diseases Branch supports integrated basic and clinical research on normal and abnormal cardiovascular development and the etiology, pathogenesis, prevention, diagnosis, and treatment of pediatric and adult structural heart disease. Research areas in heart development include normal and abnormal development, molecular and genetic etiology of cardiovascular malformations, cardiomyogenic differentiation of stem cells, and gene?environment interactions in the development of congenital heart disease. Structural disease research includes the investigation of congenital heart disease, from embryology through adulthood, and the associated exercise physiology and neurodevelopmental outcomes; valve disease; pediatric cardiomyopathy and heart transplantation; and pediatric cardiac inflammation and infection.

Heart Failure and Arrhythmias Branch

The Heart Failure and Arrhythmias Branch supports integrated basic and clinical research on normal and abnormal cardiac function to improve diagnosis, treatment, and prevention of heart failure and arrhythmias and to protect the myocardium and manage resuscitation. Heart failure research addresses the pathogenesis and treatment of heart failure and cardiomyopathies, including the use of devices, medical treatments, and cell-based therapies. Arrhythmias research investigates the etiology of rare and common arrhythmias, sudden cardiac death, and arrhythmogenesis and explores the genetic and environmental bases of normal cardiac electrical activity. Myocardium protection research focuses on stunning and hibernation, ischemic/reperfusion injury, and preconditioning. Resuscitation research includes the study of whole-body oxygen deprivation; organ preservation; and cell, tissue, and organ protection during cardiac arrest and traumatic shock.

Prevention and Population Sciences Program

The Prevention and Population Sciences Program supports and provides leadership for population- and clinic-based research on the causes, prevention, and clinical care of cardiovascular, lung, and blood diseases and sleep disorders. Areas of research include epidemiological studies to describe disease and risk factor patterns in populations and to identify risk factors for disease; clinical trials of interventions to prevent disease; genetic, behavioral, sociocultural, and environmental influences on disease risk and outcomes; and the application of prevention and treatment strategies to determine how to improve clinical care and public health.

The Program is organized into the three branches described below.

Clinical Applications and Prevention Branch

The Clinical Applications and Prevention Branch supports, designs, and conducts research and supports training on behavioral, environmental, clinical, and health care approaches to reduce the occurrence and consequences of CVD. Prevention research examines the effectiveness of interventions to slow or halt risk factor or disease development or progression. Interventions?many of which focus on high-risk individuals and populations?include medications, behavioral strategies, and environmental change. Studies to examine lifestyle, nutrition and exercise, psychological and sociocultural factors, and environmental and genetic influences relevant to prevention are supported. Also supported is clinical application research to examine approaches to improve health care delivery and patient outcomes. Studies include clinical and community trials and observational studies.

Epidemiology Branch

The Epidemiology Branch supports, designs, and conducts research and supports research training in the epidemiology of cardiovascular, lung, and blood diseases and sleep disorders. Studies are conducted to identify temporal trends and population patterns in the prevalence, incidence, morbidity, and mortality from the diseases and include single- and multicenter observational epidemiologic studies of development, progression, and treatment of cardiovascular, lung, and blood diseases and sleep disorders. Areas of emphasis include environmental, lifestyle, physiological, and genetic risk factors for disease and risk factor development including characterization of gene?gene and gene?environment interactions. Large cohorts of minority participants, such as Hispanics and blacks, have been assembled to explore health disparities in minorities. The Branch also distributes data from eligible NHLBI studies to researchers through a process that adheres to guidelines for the protection of participant privacy and confidentiality.

Women's Health Initiative Branch

The Women's Health Initiative Branch?in collaboration with the National Cancer Institute (NCI), the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the National Institute on Aging (NIA), the National Institute of Neurological Disorders and Stroke (NINDS), and the Office of Research on Women's Health (ORWH)?supports clinical trials and observational studies to improve the understanding of the causes and prevention of major diseases affecting the health of women. Current studies focus on CVD, cancer, and fractures. Large multicenter observational studies seek to identify risk markers for disease or to better quantify known markers using questionnaires, clinical examinations, and laboratory data. The large and long-term multicenter clinical trials test promising but unproven interventions?such as hormone therapy, diet, and supplements?to prevent major diseases and evaluate overall effects on health. The Branch has established an infrastructure to support the use of data and blood samples from the studies by the scientific community.

The Women's Health Initiative Memory Study (WHIMS), an ancillary study to the WHI, was designed to test whether hormone therapy prevents the development and progression of dementia symptoms in postmenopausal women.

Office of Biostatistics Research

The Office of Biostatistics Research (OBR) provides statistical expertise to the Institute and performs diverse functions in planning, designing, implementing, and analyzing NHLBI-sponsored studies. Its primary responsibility is to provide objective, statistically sound, and medically relevant solutions to problems. The OBR is expected to provide a new and valid statistical solution when presented with a problem for which techniques are not yet available. Its methodological interests concern survival analysis; longitudinal data analysis; and efficient study designs, including the monitoring of ongoing clinical studies for efficacy and safety. The OBR has recently made contributions to statistical genetics and has extended its expertise to bioinformatics.

Office of Research Training and Career Development

The Office of Research Training and Career Development supports training and career development programs in cardiovascular research for individuals at all educational levels, from high school students to faculty. It collaborates with the scientific community and professional organizations to ensure that its programs meet the needs of young scientists from diverse backgrounds. Activities include institutional and individual research training programs and fellowships; diversity supplements to provide mentored experiences with established research scientists; the Pathway to Independence Program, which allows recipients to bridge the gap between a career development award and a research award; and career development programs designed for clinical research.

Office of Special Projects

The Office of Special Projects represents the DCVS on NHLBI and NIH policy committees; oversees and works with Division leadership on selected activities of the DCVS clinical studies portfolio; fosters communication within DCVS by developing and coordinating Division-wide and Institute-wide interest groups on various topics; develops and implements specific cross-cutting projects; and provides expert consultation as needed for large-scale projects or initiative development.

The Division also supports demonstration and dissemination projects to transfer basic research and clinical findings to health care professionals and patients, and training and career development programs for individuals interested in furthering their professional abilities in lung disease research. The DLD, through the National Center on Sleep Disorders Research, coordinates sleep research activities across the NIH, other Federal Agencies, and outside organizations.

The Division is organized into the three Branches described below.

Airway Biology and Disease Branch

The Airway Biology and Disease Branch supports basic and clinical research and research training in asthma, COPD, CF, and airway function in health and disease. The Branch supports innovative genetics, genomics, and biotechnology programs to advance discovery of lung disease risk factors, mechanisms, and treatment. It also funds applied studies to develop new methods of lung imaging. Additionally, the Branch focuses on health education research and demonstration and education projects for the management of asthma and COPD.

Asthma research investigates the origins, pathogenesis, and management of asthma, including the role of immunologic and nonimmunologic events and inflammation in its pathogenesis; the genetics of asthma and atopy; airway remodeling and repair in asthma; the mechanisms of severe asthma; and the regulation of mucous hypersecretion and mucous cell metaplasia.

Research on COPD and other diseases of the lung related to smoking or environmental exposures explores pathogenetic mechanisms involved in the development and progression of COPD, emphysema, and lung disease associated with alpha-1-antitrypsin deficiency; genetic determinants of lung disease; treatment of COPD; and properties and health effects of air pollution.

Research on CF focuses on the function of the CF transmembrane conductance regulator and its role in lung disease. Areas of interest include airway epithelial ion transport, airway surface liquids, animal and cellular models for CF, signaling pathways in airway cells, regulation of mucin expression and secretion, development and clinical testing of treatments, and mechanisms underlying the infectious and inflammatory aspects of CF lung disease.

Lung Biology and Disease Branch

The Lung Biology and Disease Branch supports basic, translational, and clinical research and research training programs in pulmonary conditions associated with human immunodeficiency virus (HIV)/AIDS, tuberculosis, acute lung injury and critical care medicine, lung development and pediatric lung diseases, lung immunobiology and interstitial lung diseases, lymphangioleiomyomatosis, and lung cell and vascular biology. In addition, it supports the development of tuberculosis curricula for medical schools.

AIDS and tuberculosis research focuses on the pathogenesis and course of pulmonary manifestations of HIV infection and tuberculosis and host lung defenses against them and HIV-associated opportunistic infections. Emphasis is on identifying and understanding the pathogenesis of lung complications associated with HIV infection and characterizing the lung microbiome in HIV-infected and HIV-uninfected individuals.

Research on acute lung injury and critical care medicine explores the pathogenesis, treatment, and prevention of acute lung injury and acute respiratory distress syndrome (ARDS). The Branch supports development of new diagnostic tools for detection of acute lung injury and development of an artificial lung and oversees clinical studies of therapies for ARDS, including the ARDS Network.

Research in developmental biology and pediatric pulmonary diseases investigates the regulation of lung development, growth, and repair and focuses on pediatric pulmonary diseases in infants and children, including bronchopulmonary dysplasia, congenital and acquired upper airway abnormalities, and persistent pulmonary hypertension of the newborn. Research also focuses on identifying and determining the cell fate of lung progenitor stem cells, understanding lung regeneration, and exploring cell-based therapy for lung injury and disease.

Research on immunology and fibrosis includes studies of interstitial pulmonary fibrosis, sarcoidosis, occupational and environmental lung diseases, and the role of immune response and inflammation in these diseases. The Branch also supports research on lung immunobiology, lung transplantation, and pathogenesis of lymphangioleiomyomatosis.

Lung cell and vascular biology research investigates lung cell biology and function and pulmonary vascular disease, including pulmonary arterial hypertension and pulmonary embolism diagnosis. Research focuses on pulmonary alveolar epithelial cells, vascular endothelial cells, and the lung surfactant system. The Branch also performs research on the regulation of barrier function of pulmonary endothelial cells and regulation of lung permeability.

National Center on Sleep Disorders Research

The National Center on Sleep Disorders Research (NCSDR) supports research, health education, and research training related to sleep-disordered breathing and the fundamental function of sleep and circadian rhythms. Specific areas of interest include neurobiology of ventilatory control, respiratory rhythmogenesis, chemosensitivity, basic neurobiology of sleep?wake regulation, circadian-coupled cellular function, and effects of sleep deprivation. The NCSDR also stewards several forums, including the Sleep Disorders Research Advisory Board and the Trans-NIH Sleep Research Coordinating Committee, that facilitate the coordination of sleep research across the NIH and with other Federal Agencies and outside organizations. The Center participates in translation of new sleep research findings for dissemination to health care professionals and the public.

Division of Blood Diseases and Resources

The DBDR supports research and research training on the causes, diagnosis, treatment, and prevention of nonmalignant blood diseases, including anemias, SCD, and thalassemia; premalignant processes, such as myelodysplasia and myeloproliferative disorders; hemophilia and other abnormalities of hemostasis and thrombosis; and immune dysfunction. It supports a SCCOR and other specialized centers that focus on clinical collaborative research in hemostatic and thrombotic diseases, SCD, and cell-based therapies for blood diseases.

The Division also supports research in transfusion medicine and blood banking, stem cell biology and disease, hematopoiesis, clinical cellular medicine, and blood supply adequacy and safety. It provides biospecimens and cellular resources to the scientific community.

The Division is organized into the three Branches described below.

Blood Diseases Branch

The Blood Diseases Branch supports research and research training in blood diseases, including SCD, thalassemia, Fanconi anemia, Diamond-Blackfan anemia, and other aplastic anemias and malaria. Additionally, it supports outcomes-related research. Research in SCD and thalassemia focuses on elucidating the etiology and pathophysiology of the diseases and improving disease treatment and management. Areas of emphasis include genetics, regulation of hemoglobin synthesis, iron chelation, development of drugs to increase fetal hemoglobin production, hematopoietic transplantation, and gene therapy. Basic and translational red cell research are also areas of interest.

The Branch also supports research on the pathogenesis of arterial and venous thrombosis to improve the diagnosis, prevention, and treatment of thrombosis in heart attack, stroke, and peripheral vascular diseases. A major goal is to find additional platelet inhibitors, anticoagulants, and fibrinolytic agents to treat thrombotic and thromboembolic disorders with better specificity and fewer side effects than those currently used for treatment.

Transfusion Medicine and Cellular Therapeutics Branch

The Transfusion Medicine and Cellular Therapeutics Branch supports research and research training in transfusion medicine, stem cell biology and disease, hematopoiesis, clinical cellular medicine, and blood supply adequacy and safety. Research focuses on the use, safety, and availability of blood and blood components for transfusion and cellular therapies. Research areas include transmission of disease, noninfectious complications of transfusions, immunobiology, cell biology and disease, novel cell-based therapies, hematopoietic stem cell transplantation, and overall product availability. The Branch develops programs for basic and clinical research related to normal and abnormal cellular biology and pathology. It also collaborates with governmental, private sector, and international organizations to improve the safety and availability of the global supply of blood and blood components. The Branch also supports major NHLBI resource programs that provide cellular therapeutic products and biospecimens to the NHLBI scientific community.

Division of Intramural Research

The DIR conducts laboratory and clinical research in heart, vascular, lung, blood, and kidney diseases and develops technology related to cardiovascular and pulmonary diseases. Areas of interest include the biologic basis of arteriosclerosis and its manifestations; pathophysiology of hypertensive vascular disease; functions of the lung; clinical and experimental studies on physiologic and pharmacologic aspects of heart, lung, and blood diseases; and a broad program of other basic research and technical developments related to them.

The DIR is organized into the four Centers and three Branches described below.

Cell Biology and Physiology Center

The Cell Biology and Physiology Center develops a global view of the mechanisms that regulate cellular function and physiology. It evaluates the mechanisms that control different molecular machines within the cytosol, including those involved in muscle contraction and cytosolic and membrane transport processes. The Center studies cellular signaling events associated with hormone action, cytosolic trafficking, and energy metabolism; investigates the role of cellular processes on function and adaptation in whole-animal model systems; and develops unique measuring devices for studying biochemical and physiological processes in intact cells, whole animals, and clinical situations.

Genetics and Development Biology Center

The Genetics and Development Biology Center develops a global view of the mechanisms that regulate cardiovascular development and the etiology of congenital heart anomalies and CVD. It evaluates the function of specific genes and transcription factors in the development of the heart and other tissues, develops techniques and approaches for gene delivery and gene therapy in model systems, and works toward a better understanding of basic processes involved in regulating and interpreting the genetic code in development and disease.

Immunology Center

The Immunology Center develops a global view of the molecular basis of immune processes. It studies the intracellular and signaling processes involved in the activation of lymphocytes and mast cells, investigates the mechanisms by which drugs and other agents result in allergic-autoimmune reactions, and relates the results to the development of new diagnostic and therapeutic approaches in humans.

Translational Medicine Branch

The Translational Medicine Branch conducts biomedical research directed at defining normal and abnormal biologic function at the molecular level. It develops diagnostic and therapeutic modalities for the treatment and understanding of CVD and implements mechanism-based clinical studies centered on innovative discoveries and observations from inside and outside the Branch.

Hematology Branch

The Hematology Branch conducts basic and clinical research on normal and abnormal hematopoiesis. Areas of interest include bone marrow failure, viral infections of hematopoietic cells, gene therapy of hematologic and malignant diseases, bone marrow transplantation, and mechanisms of immunologically mediated syndromes, such as graft-versus-host disease and autoimmune diseases.

Pulmonary and Vascular Medicine Branch

The Pulmonary and Vascular Medicine Branch conducts research on the lung, heart, and systemic vasculature directed at defining normal physiological function and novel mechanisms of disease at the molecular, biochemical, and functional levels. It conducts research on emerging diseases of the lung characterized by unknown etiology and molecular pathogenesis. Areas of interest include lung diseases in blacks, such as SCD and sarcoidosis; the role of nitric oxide, nitrite, gender, preconditioning, and mitochondrial function on the modulation of ischemia and reperfusion injury of the heart and lung; and translational study and drug development for therapeutic modulation of vascular, pulmonary, and cardiac cellular and molecular dysfunction in diseases of the lung and heart.

Division for the Application of Research Discoveries

The DARD supports efforts to advance the application of scientific discoveries for preventing, detecting, and treating cardiovascular, lung, and blood diseases and sleep disorders to improve the health of all Americans. It focuses on translating scientific evidence into clinical guidelines for physicians to implement in their practice and into community health promotion or education programs for communities to disseminate to the public. The Division uses several channels of communications, including communities of practice, knowledge networks, social media, Web sites, conferences, and symposia. DARD programs reach out to people in high-risk, low-income communities to improve health and reduce health disparities. DARD activities promote communication and collaboration among researchers, clinical and public health practitioners, patients, and the general public. They also focus on identifying gaps in knowledge that can be addressed by future research.

The Division is organized into the two Branches described below.

Research Translation Branch

The Research Translation Branch interprets research findings into effective approaches for practice. The Branch synthesizes and organizes evidence around priority diseases or conditions and leads the effort to develop both evidence-based systematic literature reviews and guidelines for clinical practice. The Branch also develops clinical decision support systems and other innovative applications for use in clinical and public health practice settings, and it facilitates knowledge exchange opportunities for researchers and practitioners around issues of research applicability and relevance to practice. Branch activities also identify knowledge gaps to inform future research.

Enhanced Dissemination and Utilization Branch

The Enhanced Dissemination and Utilization Branch collects, synthesizes, and communicates evidence-based findings on the determinants of population health to maintain and improve the health of diverse populations and reduce health disparities in underserved groups. The Branch translates research into effective community health promotion programs, establishes effective partnerships to improve health and reduce health disparities, and builds communication among organizations and communities to ensure their personal involvement in improving community health. Results are achieved by providing technical assistance and information resources to diverse audiences, including high-risk and underserved groups in a variety of community practice settings. The Branch identifies appropriate health outcomes for assessing successful implementation and conducts evaluation activities to ensure continuous improvement and inform program planning.